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Applied and Environmental Microbiology, March 2000, p. 914-919, Vol. 66, No. 3
0099-2240/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Influence of Acanthamoeba castellanii on
Intracellular Growth of Different Legionella Species in
Human Monocytes
B.
Neumeister,1,*
G.
Reiff,1
M.
Faigle,1
K.
Dietz,2
H.
Northoff,1 and
F.
Lang3
Abteilung
Transfusionsmedizin,1 and
Physiologisches Institut,3
Universitätsklinikum Tübingen, 72076 Tübingen, and
Institut für Medizinische Biometrie,
Universitätsklinikum Tübingen, 72070 Tübingen,2 Germany
Received 1 September 1999/Accepted 10 December 1999
 |
ABSTRACT |
Previous studies using a murine model of coinhalation of
Legionella pneumophila and Hartmannella
vermiformis have shown a significantly enhanced intrapulmonary
growth of L. pneumophila in comparison to inhalation of
legionellae alone (J. Brieland, M. McClain, L. Heath, C. Chrisp, G. Huffnagle, M. LeGendre, M. Hurley, J. Fantone, and C. Engleberg,
Infect. Immun. 64:2449-2456, 1996). In this study, we introduce an in
vitro coculture model of legionellae, Mono Mac 6 cells (MM6) and
Acanthamoeba castellanii, using a cell culture chamber
system which separates both cell types by a microporous polycarbonate
membrane impervious to bacteria, amoebae, and human cells. Whereas
L. pneumophila has shown a maximal 4-log-unit
multiplication within MM6, which could not be further increased by
coculture with Acanthamoeba castellanii, significantly enhanced replication of L. gormanii, L. micdadei, L. steigerwaltii, L. longbeachae, and L. dumoffii was seen after coculture
with amoebae. This effect was seen only with uninfected amoebae, not with Legionella-infected amoebae. The supporting effect for
intracellular multiplication in MM6 could be reproduced in part by
addition of a cell-free coculture supernatant obtained from a
coincubation experiment with uninfected A. castellanii and
Legionella-infected MM6, suggesting that amoeba-derived
effector molecules are involved in this phenomenon. This coculture
model allows investigations of molecular and biochemical mechanisms
which are responsible for the enhancement of intracellular
multiplication of legionellae in monocytic cells after interaction with amoebae.
 |
INTRODUCTION |
In 1980, Rowbotham published the
first report on intracellular multiplication of Legionella
pneumophila within Acanthamoeba spp. and
Naegleria spp. (33). Thereafter, several reports
described the replication of Legionella culture isolates
from clinical samples within protozoa isolated from the presumed source
of infection (2, 6, 21-23, 29, 34, 36, 45). Intracellular
growth within protozoa enhances the ability of L. pneumophila to infect human monocytes (18), induces
phenotypic modulation (1, 4), and causes resistance to
chemical disinfectants, biocides, and antibiotics (3, 5).
Inhalation of legionellae packaged in amoebae results in the induction
of more-severe clinical cases of legionellosis (31, 33).
This speculation was supported by a recently published mouse model of
coinhalation of L. pneumophila and Hartmannella vermiformis. Coinhalation with H. vermiformis
significantly enhanced the intrapulmonary growth of L. pneumophila, resulting in greater mortality than that from
inhalation of legionellae alone (7). Intrapulmonary growth
of mutant strains of L. pneumophila with reduced virulence
for H. vermiformis but maintained virulence for monocytes
was not significantly enhanced by coinhalation (8). Intrapulmonary growth of L. pneumophila was significantly
greater in mice inoculated with L. pneumophila-infected
H. vermiformis than in mice inoculated with an equivalent
number of bacteria or coinoculated with L. pneumophila and
uninfected H. vermiformis (9). The mechanism of
intrapulmonary growth enhancement of legionellae by amoebae remains to
be determined. We therefore established an in vitro coculture model of
the Mono Mac 6 cell line (MM6), Acanthamoeba castellanii,
and Legionella species with different intracellular growth
rates within MM6 (30) in order to analyze the underlying
molecular and biochemical mechanisms.
 |
MATERIALS AND METHODS |
Bacteria.
Legionella spp. L. gormanii ATCC
32979 (isolated from soil of a creek bank), L. longbeachae
serogroup 1 ATCC 33462 (isolated from human lung), L. dumoffii ATCC 33279 (isolated from a cooling tower), L. micdadei ATCC 33218 (isolated from human blood via the yolk sac),
and L. steigerwaltii ATCC 35302 (isolated from tap water)
were obtained from the American Type Culture Collection. L. pneumophila serogroup 1 subtype Pontiac (isolated from a patient with severe Legionella pneumonia and passaged less than
three times on buffered charcoal yeast extract agar (BCYE agar) was kindly provided by G. Ruckdeschel (University of Munich, Munich, Germany). Bacteria were grown on BCYE agar (Oxoid, Wesel, Germany) at
35°C in 3% CO2 for 3 to 5 days.
MM6.
MM6 were kindly supplied by H. W. L. Ziegler-Heitbrock (University of Munich) and were cultured as
replicative nonadherent monocytes under lipopolysaccharide-free
conditions in 250-ml flasks (Nunc, Roskilde, Denmark) in 25 ml of RPMI
1640 medium (Gibco, Eggenstein, Germany) supplemented with 10% fetal
calf serum (FCS) (Myoclone Superplus; Gibco), 2 mM
L-glutamine (Gibco), 1 mM pyruvic acid (Fluka, Buchs,
Switzerland), 1% nonessential amino acids (Gibco), 9 mg of insulin
(Sigma, Munich, Germany)/ml, and 1 mM oxalacetate (Sigma) (MM6 medium)
at 35°C in 5% CO2 as described by Ziegler-Heitbrock et
al. (47). Cells were diluted 1:3 twice a week in fresh medium.
A. castellanii.
A. castellanii ATCC 30234 was
grown in 250-ml flasks (Nunc) in 25 ml of PYE broth [2% proteose
peptone no. 3 (Difco, Detroit, Mich.), 0.1% yeast extract (Difco), 0.1 M glucose, 4 mM MgSO4, 0.4 M CaCl2, 0.1%
sodium citrate dihydrate, 0.05 mM
Fe(NH4)2(SO4)2 · 6H2O, 2.5 mM NaH2PO3, 2.5 mM
K2HPO3 (Sigma), pH 6.5] at 35°C in 5%
CO2 as described by Moffat and Tompkins (28) and
was diluted 1:2 twice a week.
In vitro infection of MM6 and A. castellanii.
Nonadherent MM6 were harvested by centrifugation at 400 × g for 10 min. The pellet was washed twice in MM6 medium without FCS. Legionellae were harvested from BCYE agar, suspended in MM6 medium
without FCS, and adjusted to an optical density at 578 nm of 0.2 (Ultrospec 2000; Pharmacia, Freiburg, Germany), corresponding to a
concentration of legionellae of approximately 3 × 108
CFU/ml. For concentration, bacteria were centrifuged at
3,000 × g for 15 min. MM6 (2 × 107)
were pelleted and resuspended with 2 × 109
legionellae in a volume of 1.5 ml in a well of a six-well tissue culture plate (Nunc) to provide a bacteria-to-cell ratio of 100:1 and
were incubated in the presence of legionellae at 35°C in 5% CO2 for 2 h. After this period, nonphagocytized
bacteria were killed by the addition of 4.5 ml of MM6 medium without
FCS containing 100 µg of gentamicin/ml for 1 h at 35°C in 5%
CO2. After three washes by centrifugation at 300 × g for 15 min, the cells were resuspended in coculture medium
(see below) and distributed in 1-ml aliquots into the wells of a
24-well tissue culture plate (Nunc), giving a concentration of
106 infected MM6 per well. This time point was defined as
time zero. Elimination of extracellular bacteria after exposure to
gentamicin was verified by plating an aliquot of all washing solution
onto BCYE agar.
The cells were then incubated for an additional 72 h at 35°C in
5% CO2. Every 24 h, the contents of two wells were
aspirated and pelleted by centrifugation at 400 × g
for 10 min. Supernatant was transfered into a sterile tube. One
milliliter of sterile distilled water was added to the pellet, and
final disruption of the cells was performed by aspirating the
suspension through a 27-gauge needle. Supernatant and lysis fluid were
pooled, and serial 10-fold dilutions were made. Then, 0.1 ml of each
dilution was inoculated onto BCYE agar to determine the number of
culturable legionellae after multiplication in MM6. Colonies on the
agar were counted on day 5 after incubation at 35°C in 5%
CO2.
The viability of MM6 and
A. castellanii was determined by
trypan blue exclusion at the time points indicated
above.
In experiments using infected amoebae, in vitro infection of
A. castellanii was performed in an identical manner except that
legionellae were suspended in amoebae buffer (PYE broth without
glucose) (
30).
Coculture of MM6 and A. castellanii.
Infected MM6 were
resuspended in a mixture of 50% MM6 medium without FCS and 50% PYE
broth without glucose NaCl was added to yield a NaCl concentration of
6.5 g/liter (coculture medium), identical to that in MM6 medium. This
mixture was found to support the growth of MM6 and A. castellanii as well as the above-described original cell culture
media for these cells. Infected MM6 were then distributed in 1-ml
aliquots into the wells of a 24-well tissue culture plate, giving a
concentration of 106 infected MM6 per well. A. castellanii cells (106; uninfected or infected) were
resuspended in coculture medium and were added using a Transwell insert
(Costar, Bodenheim, Germany) which separated both cell types by a
microporous polycarbonate membrane with a pore size of 0.1 µm,
impervious to bacteria, amoebae, and MM6. The absence of legionellae
from the upper chamber (uninfected A. castellanii) was
determined by means of culture on BCYE agar, and the sterility of the
coculture was checked by culture on Columbia blood agar (Oxoid).
The coculture was incubated for 72 h. In some experiments,
10
6 infected MM6 per well were coincubated for 72 h
with a cell-free
Transwell supernatant from a coincubation experiment
of
A. castellanii and MM6 infected with legionellae.
Cell-free Transwell supernatant
was obtained by harvesting the content
of a Transwell insert (i.e.,
noninfected amoebae in coculture with
infected MM6 and both host
cells separated by a microporous membrane),
with subsequent
centrifugation.
Intracellular multiplication of legionellae in MM6 was determined as
described in the previous
section.
Multiplication within MM6 in coculture with
A. castellanii
or supernatant was compared with multiplication within MM6 in coculture
medium. All experiments were done at least in
triplicate.
Statistical analysis of data.
Based on the
maximum-likelihood method, assuming a Poisson distribution, the number
of bacteria in each experiment was estimated by dividing the sum of
bacterial counts for different dilutions by the sum of dilution factors
(32). The response variable was always the logarithm of the
ratio of the bacterial counts at 72 h divided by the initial
value, which is called the log multiplication within 72 h. For
each species, a multifactorial analysis of variance (ANOVA) was carried
out separately and included the factors (when applicable) date of
experiment, coculture with A. castellanii, coculture with
either uninfected or infected amoebae, supernatant from coculture of
A. castellanii with MM6 infected with certain Legionella species, and NaCl supplementation and their
interactions. The ANOVA models provide least-squares mean estimates of
bacterial multiplication within 72 h in MM6 together with their
95% confidence limits. Post-hoc t tests for individual
contrasts were adjusted (when necessary) by the method of Bonferroni.
An overall significance level of 5% was adopted. Statistical analyses
were performed using the statistics package JMP, version 3.2.2.
 |
RESULTS |
Viability of MM6 and A. castellanii in coculture
medium.
MM6 medium without FCS and amoeba buffer without glucose
were mixed in different ratios. This mixture was supplemented with NaCl
to yield a NaCl concentration of 6.5 g/liter. MM6 and A. castellanii were cultured in this mixture, and cell viability was
determined by trypan blue exclusion. At a ratio of 50% MM6 medium and
50% amoeba buffer, the viability of both MM6 and A. castellanii was similar to that in the original culture media. This mixture was chosen as the coculture medium for further experiments.
Multiplication of different Legionella species in MM6
and influence of coculture with A. castellanii.
Legionellae
could not multiply within MM6 medium, amoeba medium, or coculture
medium without the addition of host cells (data not shown). After in
vitro infection of MM6, the level of intracellular L. pneumophila increased by more than 4 orders of magnitude over a
72-h period. This maximal replication could not be further enhanced by
the addition of A. castellanii. L. gormanii,
L. micdadei, L. steigerwaltii, and L. longbeachae showed only moderate intracellular multiplication in
MM6, which was significantly enhanced by coculture with amoebae. While
L. dumoffii was not able to multiply within MM6, the
addition of A. castellanii induced a 10-fold increase for
this species (Fig. 1). The supporting
effect of coculture with amoebae for intracellular growth of
legionellae in MM6 was seen only with uninfected amoebae. A. castellanii infected with L. dumoffii was not able to
enhance the intracellular growth of L. dumoffii in MM6 when
used in coculture (Fig. 2).

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FIG. 1.
Multiplication of different Legionella
species in MM6 and influence of coculture with A. castellanii. Data are means ± 95% confidence limits from
three experiments. *, P < 0.05; **, P < 0.01; n.s., not significant.
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FIG. 2.
Multiplication of L. dumoffii in MM6 in
coculture with uninfected and L. dumoffii-infected A. castellanii (A. cast.). Data are means ± 95% confidence
limits from three experiments. **, P < 0.01.
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|
Multiplication of different Legionella species in MM6
coincubated with supernatants obtained from a coculture of L. dumoffii-, L. steigerwaltii-, or L. longbeachae-infected MM6 with A. castellanii.
In some
coculture experiments, A. castellanii was replaced by a
cell-free Transwell supernatant obtained from a coincubation experiment
of A. castellanii and MM6 infected with L. dumoffii, L. steigerwaltii, or L. longbeachae. Coculture supernatant of uninfected MM6 and A. castellanii served as the control. Intracellular growth of
L. dumoffii in MM6 was significantly enhanced by the addition of supernatants, which were obtained after 48 and 72 h of
coculture of L. dumoffii-infected MM6 and A. castellanii. The addition of supernatant which was obtained after
48 h of coculture of L. steigerwaltii-infected MM6 and
A. castellanii also had a potentiating, although not
significantly so, effect on the intracellular growth of L. dumoffii (Fig. 3).

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FIG. 3.
Multiplication of L. dumoffii in MM6
coincubated with supernatant obtained from a coculture of L. dumoffii- or L. steigerwaltii-infected MM6 with
uninfected A. castellanii. Control, coculture supernatant
from uninfected MM6 and A. castellanii. Data are means ± 95% confidence limits from three experiments. *, P < 0.05; **, P < 0.01.
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|
Intracellular multiplication of
L. longbeachae was also
significantly enhanced by supernatants from cocultures of
L. steigerwaltii-
and
L. dumoffii-infected MM6 and
A. castellanii (Fig.
4).
Replication
of
L. steigerwaltii in MM6 could not be
influenced by the addition
of supernatant (Fig.
5).

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FIG. 4.
Multiplication of L. longbeachae in MM6
coincubated with supernatant obtained from a coculture of L. dumoffii-, L. longbeachae-, or L. steigerwaltii-infected MM6 with uninfected A. castellanii. Data are means ± 95% confidence limits from
three experiments. *, P < 0.05.
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FIG. 5.
Multiplication of L. steigerwaltii in MM6
coincubated with supernatant obtained from a coculture of L. dumoffii-, L. longbeachae-, or L. steigerwaltii-infected MM6 with uninfected A. castellanii. Data are means ± 95% confidence limits from
three experiments.
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|
Influence of NaCl content of coculture medium on intracellular
replication of L. dumoffii in MM6.
The NaCl content of
coculture medium had a considerable influence on the intracellular
multiplication of legionellae in MM6, as shown, e.g., for L. dumoffii. Coculture medium without supplementation of NaCl
significantly enhanced the intracellular multiplication of L. dumoffii in the absence as well as in the presence of A. castellanii. The supporting effect of coculture with amoebae was more pronounced in coculture medium without supplementation of NaCl
(Fig. 6).

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FIG. 6.
Influence of NaCl content of coculture medium on
intracellular replication of L. dumoffii in MM6. Data are
means ± 95% confidence limits from three experiments.
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 |
DISCUSSION |
Recently, Brieland et al. investigated the effect of inhaled
H. vermiformis on the pathogenesis of Legionnaires' disease
in a murine model (7, 9). They found that intratracheal
coinoculation of L. pneumophila and amoebae as well as
inoculation of L. pneumophila-infected amoebae significantly
enhanced the intrapulmonary growth of L. pneumophila in A/J
mice. The mechanism by which intrapulmonary H. vermiformis
potentiates the replication of L. pneumophila in the rodent
lung and the relevance of these findings for human infections remained
unclear. Amoeba-induced inhibition of proinflammatory cytokine
production could be excluded, since coinhalation as well as inhalation
of L. pneumophila-infected H. vermiformis induced significantly enhanced levels of gamma interferon and tumor necrosis factor alpha in A/J mice, levels similar to those induced during replicative lung infections induced by L. pneumophila alone.
Three possible explanations for the potentiating effect of coinhalation
for Legionella infection were discussed: modification of the
host response to L. pneumophila infection by amoebae,
function of amoebae as implanted host cells, and enhanced virulence of amoeba-associated bacteria (7).
In this study, we introduce a coculture model of legionellae, MM6, and
A. castellanii that enables molecular and biochemical investigations of interactions between amoebae, bacteria, and human
monocytes as the typical host cells in human Legionella infections. Legionella species which show different human
prevalences and different degrees of multiplication within MM6 were
investigated. The first observed replication in MM6 and A. castellanii of the Legionella species investigated in
this model has been described recently (30).
We could show that the number of cells of L. pneumophila,
the most common cause of Legionnaires' disease, increased by more than
4 orders of magnitude over a 72-h period in MM6. This maximal multiplication within MM6 could not be further enhanced by coculture with A. castellanii (Fig. 1). This result is in contrast to
those obtained with the A/J mouse model, where coinhalation of L. pneumophila and uninfected H. vermiformis resulted in
an increase of intrapulmonary L. pneumophila in mice
(7). Use of different amoebal hosts, different
multiplicities of infection, and interference with other host cells and
their mediators in the mouse model could possibly be the reasons for
the contrasting results between the animal model and the in vitro
model. In our coculture model, maximal intracellular multiplication of
L. pneumophila within MM6 seems to be independent from
support by amoebae.
Less-common causes of legionellosis such as L. micdadei,
L. gormanii, L. longbeachae, and L. dumoffii or environmental species such as L. steigerwaltii showed moderate or deficient intracellular multiplication in MM6, which was significantly enhanced by coculture with amoebae (Fig. 1). We showed in a previous investigation that L. dumoffii is the only one of these species which is able
to grow efficiently within A. castellanii (30), a
phenomenon which can be explained by the specialized adaptation of
certain Legionella species to certain protozoa (19, 20,
24, 28, 35, 37, 39, 40). In the mouse model, only strains of
L. pneumophila which were able to replicate within H. vermiformis showed maximal intrapulmonary growth when coinoculated
with amoebae, whereas the growth of mutants with reduced virulence for
H. vermiformis was not potentiated by coinhalation
(8). In the in vitro coculture model of MM6 and A. castellanii, significant enhancement of intracellular multiplication in MM6 could also be achieved by coculture of MM6 and
amoebae for species which are not able to multiply in A. castellanii.
When L. dumoffii was used for infection, the potentiating
effect of coculture with amoebae for intracellular growth of
legionellae in MM6 was seen only with uninfected amoebae, whereas
A. castellanii infected with L. dumoffii was not
able to enhance the intracellular growth of L. dumoffii in
MM6 when used in coculture (Fig. 2). In the mouse model of
coinhalation, intrapulmonary growth of L. pneumophila was
significantly greater in mice inoculated with L. pneumophila-infected H. vermiformis than in mice
inoculated with an equivalent number of bacteria or coinoculated with
L. pneumophila and uninfected H. vermiformis
(9). The difference between this animal model and our
results could be due to the different Legionella species
used for the investigations or due to the separation of the cell
populations in the in vitro model, whereas the mouse model allowed
close contact between lung macrophages and
Legionella-infected amoebae.
The supporting effect of coculture on the replication of L. dumoffii in MM6 could be reproduced by the addition of
supernatants, which were obtained after 48 and 72 h of coculture
of L. dumoffii-infected MM6 and A. castellanii
(Fig. 3). Intracellular multiplication of L. longbeachae was
also significantly enhanced by supernatants from cocultures of L. steigerwaltii- and L. dumoffii-infected MM6 and
A. castellanii (Fig. 4). Replication of L. steigerwaltii in MM6 could not be influenced by the addition of
supernatant (Fig. 5). These data suggest (i) that despite enhanced
intracellular multiplication in MM6 during coculture with A. castellanii (Fig. 1), supernatants from coculture of A. castellanii and L. longbeachae-infected MM6 were not
able to stimulate intracellular replication (Fig. 4 and 5) and (ii)
that only certain Legionella species are susceptible to the
potentiating effect of coculture supernatant since intracellular growth
of L. steigerwaltii could not be influenced by the addition of supernatants (Fig. 5). The cause for these differences remains to be investigated.
The NaCl content of coculture medium had a considerable influence on
the intracellular multiplication of legionellae in MM6 as shown, e.g.,
for L. dumoffii. Coculture medium without supplementation of
NaCl significantly enhanced the intracellular multiplication of
L. dumoffii in the absence as well as in the presence of
A. castellanii. The supporting effect of coculture with
amoebae was more pronounced in coculture medium without supplementation
of NaCl (Fig. 6). The same effects could be shown for L. longbeachae, whereas intracellular multiplication of L. pneumophila was not influenced by osmolarity (data not shown). It
is well established that NaCl is inhibitory for virulent and
exponential-phase, but not for avirulent and postexponential, strains
of L. pneumophila (16, 17, 41), but we could
exclude the possibility that L. dumoffii or L. longbeachae multiplied in low-NaCl coculture medium in the absence
of host cells (data not shown). Therefore, a low NaCl concentration in
coculture medium obviously influenced the host cells. Supplementation
of the coculture medium with raffinose, KCl, or
Na2SO4 to establish an osmolarity identical to
those of MM6 medium and coculture medium with NaCl, respectively,
resulted in the complete abrogation of enhanced intracellular
replication of both Legionella species in coculture medium
(data not shown). Thus, decreased extracellular osmolarity rather than
reduced sodium or reduced chloride accounted for the stimulation of
replication. A decrease of extracellular osmolarity leads to osmotic
cell swelling, which modifies a variety of cellular functions, such as
transport, metabolism, cell proliferation, and cell death (for a
review, see reference 27). Most notably, it is well
established that cell swelling results in alkalinization whereas cell
shrinkage results in acidification of endosomal pH (10-15,
42-44). Previous investigations have shown that, due to
inhibition of the fusion of the phagosome and lysosome, the phagosome
of L. pneumophila does not become acidified (25, 26,
38) and therefore enables the intracellular multiplication of
bacteria. It remains to be determined whether or not the non-L.
pneumophila species used in this investigation are unable to avoid
acidification of their phagosomes in isotonic extracellular medium but
benefit from the alkalinization of phagosomal pH by osmotic swelling of
the host cell during incubation in hyposmolar coculture medium.
In summary, by this study we introduce a new in vitro coculture model
of legionellae, monocytes, and A. castellanii. By using non-L. pneumophila species, this model allows investigations
of mechanisms which are responsible for the enhancement of
intracellular multiplication of legionellae in monocytic cells after
interaction with amoebae. Since the stimulating effect for
intracellular replication of legionellae in monocytes could be
reproduced in part by the addition of supernatants obtained from
previous coincubation experiments, secreted amoebal substances
responsible for the phenomenon should be investigated.
We could also show that the reduced osmolarity of the cell culture
medium induced intracellular multiplication of L. dumoffii and L. longbeachae in MM6 due to the swelling of the host
cells. Studies are in progress to characterize possible underlying
cellular mechanisms, such as modulation of phagosomal pH, activity of a cell volume-regulated kinase (46), and cell volume-regulated transport systems including ion channels (27) in swollen MM6 infected with legionellae. A possible link between the effects of
coculture with amoebae and cell swelling remains to be investigated. Moreover, further studies are necessary to clarify the cause of the
differences between L. pneumophila and non-L.
pneumophila species in terms of susceptibility to
interaction with amoebae and the effect of hyposmolarity.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Abteilung
Transfusionsmedizin, Otfried-Müller-Straße 4/1,
Universität Tübingen, 72076 Tübingen, Germany. Phone:
0049 7071 2981608. Fax: 0049 7071 295240. E-mail:
Birgid.Neumeister{at}med.uni-tuebingen.de.
 |
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Applied and Environmental Microbiology, March 2000, p. 914-919, Vol. 66, No. 3
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Copyright © 2000, American Society for Microbiology. All rights reserved.
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